Pharm.D. Doctor of Pharmacy Doctor of Pharmacy General 4 — Questions and Answers
Question 1: A patient on lithium develops polyuria and polydipsia. What condition should be suspected?
- Diabetes mellitus type 2
- Nephrogenic diabetes insipidus (Correct answer)
- Syndrome of inappropriate ADH
- Hypothyroidism
Correct answer: Nephrogenic diabetes insipidus
Lithium interferes with ADH signaling in the collecting duct, causing nephrogenic diabetes insipidus.
Question 2: Which parameter determines the time required to reach steady-state plasma concentrations?
- Volume of distribution
- Bioavailability
- Half-life (Correct answer)
- Protein binding
Correct answer: Half-life
Steady-state is reached after approximately 4–5 half-lives regardless of dose or dosing interval.
Question 3: What is the mechanism of resistance when bacteria produce beta-lactamases?
- Altered penicillin-binding proteins
- Enzymatic hydrolysis of the beta-lactam ring (Correct answer)
- Efflux pump upregulation
- Reduced outer membrane permeability
Correct answer: Enzymatic hydrolysis of the beta-lactam ring
Beta-lactamases cleave the beta-lactam ring of penicillins and cephalosporins, rendering them inactive.
Question 4: A patient taking SSRIs is prescribed tramadol for pain. What serious interaction should be anticipated?
- Decreased analgesic effect of tramadol
- Serotonin syndrome (Correct answer)
- Increased risk of bleeding
- Reduced SSRI efficacy
Correct answer: Serotonin syndrome
Tramadol inhibits serotonin/norepinephrine reuptake; combined with SSRIs, it can precipitate serotonin syndrome.
Question 5: Which class of medications is associated with Steven-Johnson Syndrome as a rare but severe adverse reaction?
- ACE inhibitors
- Aromatic antiepileptics like carbamazepine (Correct answer)
- Proton pump inhibitors
- Beta-2 agonists
Correct answer: Aromatic antiepileptics like carbamazepine
Aromatic antiepileptics, especially carbamazepine, are strongly associated with Stevens-Johnson Syndrome, particularly in HLA-B*1502 carriers.
Question 6: What is the primary indication for using N-acetylcysteine (NAC) in emergency medicine?
- Opioid overdose reversal
- Acetaminophen overdose treatment (Correct answer)
- Benzodiazepine antidote
- Beta-blocker toxicity management
Correct answer: Acetaminophen overdose treatment
NAC replenishes glutathione stores to neutralize NAPQI, the toxic acetaminophen metabolite responsible for hepatotoxicity.
Question 7: Which counseling point is most important for a patient starting bisphosphonate therapy for osteoporosis?
- Take with food to reduce GI upset
- Take in the morning with full glass of water; remain upright for 30 minutes (Correct answer)
- Can be taken at bedtime for convenience
- Avoid dairy products for 24 hours after each dose
Correct answer: Take in the morning with full glass of water; remain upright for 30 minutes
Bisphosphonates must be taken on an empty stomach with 8 oz of water, and the patient must remain upright for 30 minutes to prevent esophageal erosion.
